Healthcare Provider Details

I. General information

NPI: 1497030415
Provider Name (Legal Business Name): CATHERINE MARIE OBRIEN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 VIA LIDO STE 205
NEWPORT BEACH CA
92663-3960
US

IV. Provider business mailing address

PO BOX 3534
LONG BEACH CA
90803-0534
US

V. Phone/Fax

Practice location:
  • Phone: 714-404-9224
  • Fax:
Mailing address:
  • Phone: 714-404-9224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number49636
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: